Inland Journal, March 27, 2019: Match Day And Spokane Medical Residency Programs

Mar 27, 2019

University of Washington medical student Mara Hazeltine will begin a family medicine residency in June in Spokane.
Credit Doug Nadvornick/SPR

Wednesday on the Inland Journal podcast, March 15 is one of the dates fourth-year medical students circle on their calendars. It’s Match Day, when the students learn the identity of the hospitals where they’ll work after they graduate. We’ll talk with one University of Washington medical student from Spokane who’s staying home to begin her career. And we’ll hear about progress made in expanding Spokane’s medical residency programs.

Find the Inland Journal podcast in iTunes, Google Play or NPR One or on the SPR website.

I’m Doug Nadvornick. Today on the Inland Journal podcast, we check in with one University of Washington medical student in Spokane who will soon graduate and become a doctor.

Mara Hazeltine: “I’m Mara Hazeltine. I’m originally from Spokane. I grew up in the Green Bluff area, a little more rural, fun place to grow up. I decided to go away for undergrad. I went to UW in Seattle, learned a lot about diversity there, was a resident advisor, was really involved in student government and I became passionate there about social determinants of health. Before going to medical school, I took a diversion and I joined Teach for America. I taught middle school math for a couple of years in Colorado Springs. It was one of the most amazing things I’ve ever done in my life, super important work. But I realized through teaching that health is really the foundation of being able to attain your goals. I would have kids come to school sick for weeks on end, with broken bones. Their families feared deportation if they came into clinic and so I felt like medicine was calling me.”

So she applied and was accepted into the University of Washington medical school. She chose to study in Spokane, where her family and her husband’s family still live.

Doug: “So, as you went through medical school, when was it you decided you wanted to become a family doctor?”
Mara Hazeltine: “Oh man. I think I knew I wanted to go into family medicine going into medical school, but I kept an open mind. When I started on my clerkships, I told myself that I would imagine myself as that sort of specialist and I would be that sort of person for six weeks and I ended up loving every single rotation, which I think is common for family medicine docs. I also had a lot of really great mentors my first few years who were family doctors. I think the great thing about family medicine is that they look holistically at a patient. They see the big picture. They understand if a person doesn’t have access to food or housing, that they face more medical issues. I think those social parts of it are common and important to family docs. That was inspiring for me and I continued on that path.”

And as she did, she started to make plans for becoming a family physician after her graduation this spring.

Now, the medical system is a little different than many other industries in that students can’t just graduate and then go out to take a job any old place as a doctor. They’re officially MDs, medical doctors, but they have to serve an apprenticeship first before they can hang up their shingle and open their own practices. That apprenticeship, or residency program, as it’s known, lasts anywhere from three to seven years, depending on how involved the speciality is. Family docs serve three-year residencies.

And the process for choosing an employer, and an employee, is different too.

Mara Hazeltine: “I like to describe it as a dating service. It’s a system where the applicants are basically in charge of their list. They decide who they would like to be a resident for the next four years and they put it in order. So, if you’re applying, like me, to 11 residencies, you would put in order one-to-11, which ones you would prefer to go to. And then all of the residencies in the country also rank all of the students they have interviewed, or they don’t rank them if they don’t want them to come to their residency. So they would put students in the order that they would take them. Then it goes into a computer system and it makes a match.”

March 15, give or take a day or two, is the day when medical students nationwide find out the results of those matches. Many schools sponsor match parties and let cameras in to record the blessed day. Here’s a moment from a Stanford University Match Day event.

Stanford Dean: “This clock is precise. You cannot open that envelope until this countdown gets to zero. So remember that when you get the envelope and you’re tempted to try to look inside. You cannot look at that envelope until 9 am, which is when this countdown gets to zero. [sound of crowd] Ok, everyone, if you wouldn’t mind going to a calm spot.”
Another voice: “We are at six, five, four, three, two, one.” [cheers and fade under]

Doug: “So what was it like for you that day. You all got together and this is kind of the day you’re going to find out what’s your future going to be for the next four years or so.”
Mara Hazeltine: “There’s a lot of excitement. I wasn’t expecting many people to be there because people go away on rotations and very few students stick around Spokane for their fourth year, actually. So I only expected a few students to be there and their families. But half of the room was faculty and members of the community who had really brought us up as medical students, which was so exciting to see. The people who were there for us in our first few years. And, in my case, my family was hoping that I’d stay in Spokane, so when I opened it and said Spokane, they all stood up and cheered and were really excited.”
Doug: “Did you have a lot of anxiety when you were opening that letter?”
Mara Hazeltine: “A little bit. You just never know. I think I had a good feeling about it. My husband came with me on the interview trail as well and he had a good feeling. He said when he was walking into the room, he got really nervous. He didn’t want to move away anymore and he realized just how much he loved being in this community as well. So I think he was a little more nervous than me. It worked out.”
Doug: “So when do you start? What’s the mechanics of becoming a resident?”
Mara Hazeltine: “I start in June. It starts with a crash course, a boot camp where they introduce you to the hospital system, how you chart. You meet all of your team and get used to everything and then you start after four weeks on your typical rotations.”

Mara Hazeltine [rhymes with fine] is one of five UW medical students from Washington and two from Idaho who matched with Spokane hospitals. She’s a textbook example of why Spokane community leaders sought to have medical education here. They wanted local students to have the opportunity to study medicine here and then stay here to practice.

Darryl Potyk: “We’re just thrilled that she matched here.”

Dr. Darryl Potyk is the chief of medical education for the University of Washington-Gonzaga health partnership.

Darryl Potyk: “To watch Mara go from beginning medical student to someone who is so well respected in her class, who was president of the medical student association. Mara’s gotten awards all along the way here. So, to see someone like Mara, who’s   homegrown, who’s going to stay in our community is just so gratifying and knowing that she’s not only going to grow into a great physician, but she will also, in the process, strengthen the residency program. She will strengthen our community in the long run.”

Potyk says demand among students for the UW’s Spokane program is growing.
Darryl Potyk: “We’re working hard to increase our clinical capacity so we can keep those students here, both in terms of our clerkships within the medical school, but then the big push is also with graduate medical education, making sure we have enough slots for people to stay here within eastern Washington.”

Graduate medical education is the term for the residency programs like the one Mara Hazeltine will begin in June.

Doug: “So Darryl, you talked about making sure there are enough slots that are open. As you look into the future, do you think there’s going to be more and more slots for psychiatrists and family medicine docs and the others here?”
Darryl Potyk: “As you know, I’ve been involved in medical education here for a long time, both with the residency programs and with the medical schools. A big push is now to ensure that we have enough graduate medical education for the increasing number of students across the country to not only match into the programs they need to and want to, but also to do it here in Spokane. There’s work underway right now to increase the number of residencies. There’s talk of a pediatric residency, a second family medicine residency, there’s talk about surgery residencies all here in Spokane. Those are all in the very early stages, so we don’t want to get ahead of ourselves. It’s a very complex process. But it gives us all a lot of hope and gratification to know we’re going to have an impact on our region.”

The federal government pays for most of the medical residency programs in the U.S. But in 1997, as part of a Congressional effort to control the budget deficit, the federal government determined it would not allow existing residency programs at existing hospitals to expand. So, in essence, the nation funds more or less the same number of residency programs it did 22 years ago. Hospital systems and universities are looking for creative ways to fund new programs.

Darryl Potyk: “There’s a couple of different ideas. One is that we’re utilizing hospitals that haven’t been used before and those hospitals are not capped so we can expand on those and we have five years to expand residencies in those particular locations. Also looking at the VA to bolster our residency programs. There’s really been a changing culture at the VA that’s really welcoming to medical education. They’ve done a lot of great work out there. And then there’s some alternative streams. Some of our residents are funded by another mechanism called HRSA, as opposed to being funded through Medicare. So we’re looking at all avenues to do that. And then there is talk about private funding of medical residencies, although that’s really a tough nut in realizing how much money it takes to do that. Suffice it to say we’re looking at all avenues. We’re working with the local chamber, with GSI, talking about how we can advocate, both at the state and federal level, to make some of the these changes to allow graduate medical education to grow. We’re facing a point in time here, within the next few years, where the country will probably graduate more medical students than we have slots for. That’s really a crisis. We don’t want people graduating from medical school and not being able to pursue the career that they want to and have invested in, but that we need as a country. So we’re really looking forward and trying to address that big picture concern.”
Mara Hazeltine: “The problem is that, like Dr. Potyk was saying, you have lots of medical students, lots of medical schools opening, but by the time they graduate, are there enough slots for them to go to residency, because your training is not finished until you get through residency. I tell people that your medical degree is good for just about nothing. I can go be a barista now. That would be a very expensive education to go be a barista. And so, Senate Bill 348 is called the “Resident Physician Shortage Reduction Act of 2019.” It’s a bipartisan bill and it was introduced into the Senate this February. So it would amend the Balanced Budget Act of 1997, like you were saying, which capped the number of residents, and it will increase the residency slots by three thousand each year, half of which would be used for full-time residents in shortage areas. If you really want to make a difference for the shortages that we have, especially in eastern Washington, contact your senator. That would be Patty Murray or Maria Cantwell in Washington state.”
Darryl Potyk: “We need to expand and we need to able to expand our caps. My hope is that this bill will do it, but if it doesn’t, we have to keep on pounding away. The fact that we’re capped at 1997 levels for residents, and everybody’s talking about a shortage of residents, it just doesn’t make sense. It’s great that it’s getting more national attention and I’m hopeful that, if this bill doesn’t pass, something in the near future will. Something’s got to change.”

Dr. Darryl Potyk is the chief of medical education for the University of Washington-Gonzaga health partnership. Mara Hazeltine is fourth-year medical student who will begin her career as a family medicine physician in June in Spokane.

Thursday on the Inland Journal podcast, giving prison inmates more educational options so they can succeed after they’re released. We’ll talk with the head of the Community Colleges of Spokane inmate education program at the state prison at Airway Heights.